Ovarian Cancer awareness month

Ovarian
cancer continues to have one of the highest mortality rates of any cancer, and
it is a leading cause of cancer deaths among women in the United States. This month,
we remember the mothers, sisters, and daughters we have lost to ovarian cancer,
and we extend our support to those living with this disease. We also reaffirm
our commitment to raising awareness about ovarian cancer, and to advancing our
screening and treatment capabilities for the thousands of American women who
will be diagnosed this year.

Ovarian
cancer touches women of all backgrounds and ages. Because of a lack of early
symptoms and effective screening tests, ovarian cancer is often not detected in
time for successful interventions. It is crucial that women know how to
recognize the warning signs of gynaecological cancers and can detect the
disease as early as possible. I encourage all women to learn about risk
factors, including family history, and to discuss possible symptoms, including
abdominal pain, with their doctor. Now, because of the Affordable Care Act, a
wide range of preventive screenings is available to women without any
copayments, deductibles, or coinsurance.

Definition

Ovarian
cancer is a type of cancer that begins in the ovaries. Women have two ovaries,
one on each side of the uterus. The ovaries — each about the size of an almond
— produce eggs (ova) as well as the hormones estrogens and progesterone.

Ovarian
cancer often goes undetected until it has spread within the pelvis and abdomen.
At this late stage, ovarian cancer is more difficult to treat and is frequently
fatal. Early-stage ovarian cancer, in which the disease is confined to the
ovary, is more likely to be treated successfully.

Surgery
and chemotherapy are generally used to treat ovarian cancer.

What
is ovarian cancer

Ovarian
cancer happens when cells that are not normal grow in one or both of your
ovaries. The ovaries are two small glands, located on either side of your
uterus. They produce female sex hormones and store and release eggs (ova).

Treatments
for ovarian cancer are more successful when the cancer is found early. But most
of the time, cancer has already spread by the time it is found.

This
topic is about epithelial ovarian cancer. This is cancer that grows in the
tissue covering the ovaries. It is the most common type of ovarian cancer and
usually occurs in women who are past menopause.

Experts
don’t know exactly what causes ovarian cancer. But they do know that DNA
changes play a role in many cancers.

Symptoms
of ovarian cancer may include:

·
Recent, frequent bloating.

·
Pain in the belly or pelvis.

·
Trouble eating, or feeling full quickly.

·
Urinary problems, such as an urgent need to urinate or urinating more often
than usual.

These
symptoms may be common in women who don’t have ovarian cancer. But if these
symptoms are new for you, and they happen almost daily for 2 to 3 weeks, you
should see a doctor.

Sometimes
the doctor may feel a lump in or on an ovary during a routine pelvic exam.
Often a lump may be seen during an ultrasound. Most lumps aren’t cancer.

If
your doctor thinks you may have ovarian cancer, you may have a blood test
called CA-125 (cancer antigen 125). Too much CA-125 in your blood can be a sign
of ovarian cancer. But too much CA-125 in the blood can be caused by many
things, such as the menstrual cycle, endometriosis, and uterine fibroids.

The
only way to know for sure that a woman has ovarian cancer is with biopsies
taken during surgery. Tissue samples will be sent to a lab to see if they
contain cancer.

Surgery
is the main treatment. The doctor will remove any tumours that he or she can
see. This usually means taking out one or both ovaries. It may also mean taking
out the fallopian tubes and uterus. Chemotherapy is often part of treatment. It
may be given before and after surgery.

When
you find out that you have cancer, you may feel many emotions and may need some
help coping. Talking with other women who are going through the same thing may
help. Your doctor or your local branch of the American Cancer Society can help
you find a support group.

Ovarian cancer is any cancerous growth that
may occur in different parts of the ovary. The majority of ovarian cancers
arise from the epithelium (outer lining) of the ovary. According to the
American Cancer Society it is the 8th most common cancer among women in the USA
(excluding non-melanoma skin cancers). In the UK ovarian cancer is the fifth
most common cancer among females, after breast cancer, bowel cancer, lung cancer
and uterine cancer (cancer of the uterus).

Approximately
21,000 women in the USA and 5,500 women in the UK are diagnosed with ovarian
cancer each year. Worldwide, around 140,000 women die of ovarian cancer every
year.

Tragically,
the overall five year survival rate is only 46 per cent in most developed
countries (it is lower for more advanced stages). However, according to the
National Cancer Institute, if diagnosis is made early, before the tumorhas
spread, the five year survival rate is nearer 93 per cent. In 2009 scientists
in the US said that current tests for diagnosing ovarian cancer are not good
enough .

What
are the ovaries?

The
ovary is the female gonad, while the testis is the male gonad. A gonad is a
reproductive gland that produces germ cells (gametes). A male sperm is a
gamete, and a female egg is also a gamete. Each human gamete has 23
chromosomes, half the number of chromosomes contained in most types of human
body cells.

The
ovary, also known as the egg sac, is one of a pair of reproductive glands in
women. The ovaries are located at either side of the uterus (womb), in the
pelvis. Each ovary is about the size and shape of an almond. The ovaries
produce ova (eggs) and female hormones, such asestrogen and progesterone. These
hormones regulate the menstrual cycle, pregnancy, and control the development
of female characteristics, such as body shape, body hair, breasts, etc.

During
the female menstrual cycle, which lasts about one month, one egg is released
from one of the two ovaries - the egg travels through the fallopian tube and
into the uterus. This is known as ovulation.

Cancer
of the ovary can spread to other parts of the reproductive system as well as
surrounding areas, such as the stomach, vagina and uterus. Ovarian cancer more
commonly occurs in women aged 65 or over, but can affect women of any age.

What
is cancer?

Cancer
is a class of diseases characterized by out-of-control cell growth. There are
over 100 different types of cancer that occur in various parts of the body -
each is classified by the type of cell that is initially affected.

Usually
our cells divide (multiply, form new ones) only when old and dying ones need to
be replaced. However, the controls that regulate when a cell divides as well as
when a cell should die sometimes become faulty. This may result in cells not
dying when they should, while additional cells are still being added - an
uncontrolled accumulation of cells. Eventually a mass of cells is formed - a
tumor.

What
are the symptoms of ovarian cancer?

In
the early stages, ovarian cancer usually has vague symptoms which are not easy
to recognize. In fact, doctors used to think that ovarian cancer had no
symptoms (unfortunately, many still do). Even though healthcare professionals
are much better at identifying ovarian cancer symptoms these days, patients
often attribute their symptoms to other conditions, such as pre-menstrual
syndrome, irritable bowel syndrome, or a temporary bladder problem.

The
main difference between ovarian cancer and other possible disorders is the
persistence and gradual worsening of symptoms. While most digestive disorders
have fluctuating symptoms, those of ovarian cancer are more constant and
steadily advancing.

The
following are examples of possible early symptoms of ovarian cancer:

- Pain in the pelvis

- Pain on the lower side of the body

- Pain in the lower stomach

- Back pain

- Indigestion or heartburn

- Feeling full rapidly when eating

- More frequent and urgent urination

- Pain during sexual intercourse

- Changes in bowel habits, such as constipation

As
ovarian cancer progresses these symptoms are also possible:

- Nausea

- Weight loss

- Breathlessness

- Fatigue (tiredness)

- Loss of appetite

Ovarian
cancer is not a silent killer. A study by the National Breast and Ovarian
Cancer Centre, Australia, found that 83% of women experience at least one
symptom of ovarian cancer in the year prior to their diagnosis. The researchers
also found that 17% of women waited more than three months after the onset of their
symptoms before visiting their doctor, with 8% waiting more than six months.
The most common symptoms, experienced by half of the study participants, were
abdominal symptoms such as fullness and pain. Bloating, bowel or urinary
symptoms were reported by approximately one third of participants.

If
you experience bloating, pressure or pain in the abdomen or pelvis that
persists for more than a few weeks you should see your doctor immediately. If
you have already been to the doctor and ovarian cancer was not diagnosed, but
treatment is not relieving symptoms, either see your doctor again or get a
second opinion. It is important that the evaluation includes a pelvic
examination.

People
with close family members who have/had ovarian or breast cancer should see a
doctor who is trained to detect ovarian cancer.

What
are the causes of ovarian cancer?

Although
we know that ovarian cancer, like many other cancers, is caused by cells
dividing and multiplying in an unordered way, nobody completely understands why
cancer of the ovary occurs. We know that the following risk factors are linked
to a higher chance of developing the disease:

Family
history

Most
women who develop ovarian cancer do not have an inherited gene mutation. Women
with close relatives who have/had ovarian cancer, as well as breast cancer,
have a higher risk of developing ovarian cancer compared to other women. There
are two genes - BRCA1 and BRCA2 - which significantly raise the risk. The BRCA1
and BRCA2 genes also raise the risk of breast cancer. Those genes are
inherited. The BRCA1 gene is estimated to increase ovarian cancer risk by 35%
to 70%, and the BRCA2 by 10% to 30%. People of Ashkenazi Jewish descent are at
particularly high risk of carrying these types of gene mutations.

Women
with close relatives who have/had colon cancer, prostate cancer or uterine
cancer are also at higher risk of ovarian cancer.

Genetic
screening can determine whether somebody carries the BRCA1 and/or BRCA2 genes.
Although a test for gene mutations known to significantly increase the risk of
hereditary breast or ovarian cancer has been available for more than a decade,
a study by researchers from Massachusetts General Hospital found that few women
with family histories of these cancers are even discussing genetic testing with
their physicians or other health care providers.

After
eight years of searching, an international team of scientists found that a
single nucleotide polymorphisms (SNP) on chromosome 9 that is uniquely linked
to ovarian cancer. The scientists estimated that women carrying that particular
version of the SNP on both copies of chromosome 9 have a 40 per cent higher
lifetime risk of developing ovarian cancer than women who do not carry it on
either copy of chromosome 9, while women with only one copy of the variant have
a 20 per cent higher lifetime risk of developing ovarian cancer than women who
have none.

In
March 2013, scientists from the University of Cambridge and the Institute of
Cancer research announced that they had identified over 80 genome regions that
can increase a human’s risk of developing ovarian, breast and prostate cancers.

Age

The
majority of ovarian cancers occur in women over 65 years of age. A higher
percentage of post-menopausal women develop ovarian cancer compared to
pre-menopausal women.

High
number of total lifetime ovulations

There
is a link between the total number of ovulations during a woman’s life and the
risk of ovarian cancer. Four principal factors influence the total:

- Never having been pregnant - women who have
never become pregnant have a higher risk of developing ovarian cancer compared
to women who have became pregnant. The more times a woman has become pregnant
the lower her risk is.

- Never having taken the contraceptive pill -
women who have never been on the contraceptive pill have a higher risk of
developing ovarian cancer compared to women who have. Taking the Pill for 15
years halves the risk of ovarian cancer, a study by the Collaborative Group on
Epidemiological Studies of Ovarian Cancer found.

- Early start of menstruation (early menarche)
- women who started their periods at an early age have a higher risk of
developing ovarian cancer.

- Late start of menopause - women whose
menopause started at a later age than average have a higher risk of developing
ovarian cancer.

Some
gynaecologic surgeries may reduce the risk

Women
who have had their fallopian tubes tied (tubal ligation) are estimated to have
a 67% lower risk of ovarian cancer. A hysterectomy is said to reduce the risk
by about one third.

Infertility
or fertility treatment

Some
studies have found a link between infertility treatment and a higher risk of
ovarian cancer. Nobody is yet sure whether the risk is linked to infertility
treatment, just infertility itself, or both. A Danish study published in the
peer-reviewed British Medical Journal concluded that the use of fertility drugs
does not increase a woman’s risk of developing ovarian cancer. The study
involved 54,362 women with infertility problems referred to all Danish
fertility clinics between 1963 and 1998.

Breast
cancer

Women
who have been diagnosed with breast cancer have a higher risk of developing
ovarian cancer.

Obesity/overweight

Being
obese or overweight increases the risk of developing many cancers. The more
overweight you are, the higher the risk. Several studies have also shown that
obese cancer patients are more likely to have faster advancing ones compared to
cancer patients of normal weight. Obese older women who have never used hormone
replacement therapy have nearly twice the risk of their normal weight peers of
developing ovarian cancer, according to a study by the researchers at the
National Cancer Institute.

New
research suggests that women who are overweight or obese are more likely to
develop ovarian cancer, compared with women of a healthy weight. Being
overweight or obese ‘a risk factor’ for ovarian cancer. Investigators from the
World Cancer Research Fund (WCRF) and the American Institute for Cancer
Research conducted the study as part of the WCRF’s Continuous Update Project.

Diagnosis
of ovarian cancer

There
is a tragic myth among many health care professionals and patients in too many
countries about early stage ovarian cancer having no symptoms. A UK study,
called The Target Ovarian Cancer Pathfinder study which surveyed 400 UK general
practitioners and over 1,000 women, including 132 with ovarian cancer, found
that 80% of GPs in the UK were wrongly of the view that women have no symptoms
in the early stages of ovarian cancer. Studies in countries with top healthcare
services have come up with similar findings.

The
GP (general practitioner) will carry out a vaginal examination and check for
any visible abnormalities in the uterus or ovaries. The doctor will also check
the patient’s medical history and family history. Further tests will be ordered
- these are usually done by a gynecologist - a doctor who specializes in
treating diseases of the female reproductive organs.

If
the woman is diagnosed with ovarian cancer the doctor will want to identify its
stage and grade. The stage of a cancer refers to the cancer’s spread while the
grade refers to how aggressively it is spreading. By identifying the stage and
grade of the cancer the doctor will be able to decide on the best treatment.
The stage and grade of ovarian cancer alone cannot predict how it is going to
develop.

The
following tests are used to diagnose ovarian cancer:

- Blood test

There
is a cancer marker called CA125 (cancer antigen 125) which is made by certain
cells in the body. A high blood level of CA125 may indicate the presence of
cancer, but could also be due to something else, such as infections of the
lining of the abdomen and chest, menstruation, pregnancy, endometriosis, or
liver disease. This blood test is just one test among others, designed to help
the doctor make a diagnosis. Normal blood levels of CA125 alone do not
definitely mean there is no cancer either. They are just indications.

Scanning

- This is a device that uses high frequency
sound waves which create an image on a monitor of the ovaries and their
surroundings. A transvaginal ultrasound device may be inserted into the vagina,
while an external device may be placed next to the stomach. Ultrasound scans
help doctors see the size and texture of the ovaries, as well as any cysts.

For
further information e mail to azadehhassan@yahoo.co.uk, text to
002207774469/3774469.